Special Surgical Situations and Diabetes Management: Part 1

Abstract

It is desirable to admit patients who are not controlled optimally with or without being treated by insulin. Admissions 2–3 days prior to stabilize glucose control and optimize insulin doses will help postoperatively a great deal. The attempt should be to reach a fasting blood glucose level between 80 and 120 mg/dL and a bed time level of 100–140 m/dL. It is desirable to switch the patients on long-acting insulin to intermediate-acting insulin as it provides greater flexibility to alter doses for quicker control. Changing to intermediate acting insulin should be done preferably on admission for control or at least a couple of days earlier 1–2 days before elective surgery. In cardiac surgery in particular wide swings of glycemia occur. Hence frequent perioperative blood glucose monitoring followed by action by changing insulin infusion rates or subcutaneous doses or glucose supplementation as the case may be is crucial for better postoperative outcomes.